Knowing your loved oneís wishes about
quality of life and resuscitation is important all the
time, but this information is vital when they are in the
intensive care unit. When a patient is unstable
and there is no knowledge about their wishes, all heroic
measures are done. Heroic measures include putting a
breathing tube in the mouth, performing chest
compressions and giving the patient an electrical shock
when necessary This is true even if there is no
hope of survival. If you know their wishes, let
the healthcare team know early on. It may save
sorrow and heartbreak later on.

Some patients linger in ICU.
They become weak and lack the ability to breathe without
the ventilator. Some also lack the ability to
swallow. The healthcare team may ask for
permission to place a tracheostomy and/or a feeding
tube. At this time, you should ask the team these
questions:

What will be their quality of
life?

Is the tracheostomy and/or feeding
tube permanent?

What is the plan after these
procedures? Is the plan to try to wean and
remove the ventilator or to assist for placement in
a convalescent home?

Will my loved one be in a
convalescent home until end of life?

What is the likelihood of a full
recovery?

When you hear these answers, give
permission based on what your loved oneís wishes are.
Unfortunately the stress of the situation will sometime
overwhelm families, causing them to make decisions based
on guilt or their own beliefs. Take time to really
think, would he/she want to be on a ventilator or in a
convalescent home the rest of his/her life? Remember,
it is never too early to have a living will, durable
power of attorney, or a discussion regarding your wishes
regarding quality of life. A durable power of
attorney designates someone that the patient has chosen
to make decisions for them when they are no longer able
to make decisions for themselves. Do this sooner than
later! Also, once you have had these discussions with
your loved one, be sure to stand up for your loved oneís
requests and make them known to the health care team.

Multi-disciplinary family
meetings

It is important to get frequent updates
on how your loved one is progressing while in the
intensive care unit. As discussed earlier,
communication between you and the healthcare team is
vital. However, families often complain about
receiving mixed messages from different healthcare team
members. This occurs frequently when consulting
physicians are asked by the family how the patient is
doing. They have the tendency of reporting on how
their specialized organ or system is doing, not how the
whole patient is. For example, if you ask a
cardiologist how the patient who has had abdominal
surgery is doing, he will probably respond to only how
the heart is progressing. This is not out of malice or
any intention of misleading you. It is because
many times they are only looking at their specific piece
of the puzzle.